MEDICARE: MR. GOULD DWIGHT HAYDEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	C20960	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110900	OTHER	CA	EYEMED VISION PLAN
2	00C209601	OTHER	CA	SECOND MEDI-CAL PIN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1299310001	OTHER	CA	DMERC NORIDIAN

General Provider Information

NPI Number	:	1780719062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GOULD DWIGHT HAYDEN M.D.

Provider Business Mailing Address
First Line	:	940 SYLVA LN
Second Line	:	STE.G
City	:	SONORA
State	:	CA
Zip	:	95370-5969
Country	:	US
Telephone Number	:	209-532-2020
Fax Number	:	209-532-1687

Provider Business Practice Location Address
First Line	:	940 SYLVA LN
Second Line	:	STE.G
City	:	SONORA
State	:	CA
Zip	:	95370-5969
Country	:	US
Telephone Number	:	209-532-2020
Fax Number	:	209-532-1687

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	04/12/2026

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